RT Book, Section
A1 Davidson, Michael
A1 Keeling, Samantha
A1 Pickering, Lisa
A2 Ring, Alistair
A2 Harari, Danielle
A2 Kalsi, Tania
A2 Mansi, Janine
A2 Selby, Peter
SR Print(0)
ID 1152358505
T1 Optimal First-Line Management of a Patient with Metastatic Renal Cell Carcinoma
T2 Problem Solving in Older Cancer Patients
YR 2018
FD 2018
PB Clinical Publishing
PP New York, NY
SN 9781846921100
LK hemonc.mhmedical.com/content.aspx?aid=1152358505
RD 2021/03/06
AB An  84-year-old  woman  presented  with  a  6  month  history  of  fatigue  and  haematuria.  She  had  a  background  history  of  hypertension,  type  2  diabetes,  chronic  kidney  disease  stage  3a  (glomerular  filtration  rate  45-59  ml/min)  and  heart  failure  New  York  Heart  Association  class  II.  Her  medications  were  metformin,  gliclazide,  amlodipine,  ramipril,  simvastatin,  bendroflumethiazide  and  aspirin.  Physical  examination  revealed  a  left-sided  flank  mass  but  was  otherwise  unremarkable.  Her  Karnofsky  performance  status  (PS)  was  80%.  A  staging  CT  scan  showed  an  8  cm  renal  mass  with  multiple  metastases  throughout  both  lung  fields.  Image-guided  biopsy  confirmed  clear  cell  metastatic  renal  cell  carcinoma  (mRCC).She  was  referred  to  a  geriatrician  for  optimization  of  medical  comorbidities  and  for  oncology  assessment.  After  discussion  with  the  patient  and  family,  the  decision  was  made  to  commence  pazopanib.  After  2  weeks  of  pazopanib  she  described  grade  1  fatigue,  grade  1  diarrhoea,  grade  1  hand-foot  syndrome  and  grade  3  hypertension.  A  treatment  break  was  initiated,  her  ACE  inhibitor  and  calcium  channel  blocker  were  escalated  to  maximum  dose  and  loperamide  was  recommended.  Repeat  BP  monitoring  after  7  days  showed  adequate  control,  and  pazopanib  was  reintroduced  with  a  dose  reduction.Is  systemic  anticancer  treatment  indicated  in  this  case?What  are  the  first-line  treatment  options  for  mRCC  and  what  is  the  evidence  for  their  use?What  impact  do  the  patient's  age  and  comorbidities  have  on  treatment  decision  making?How  could  the  patient's  comorbidities  be  optimized  prior  to  tyrosine  kinase  inhibitor  (TKI)  therapy?How  can  toxicities  be  pre-emptively  managed  in  this  patient?